Blue Cross Medicare Advantage Protect (PPO) Medicare Advantage Plan H0107-011 • 2026 • Golden Valley County, MT

Blue Cross Medicare Advantage Protect Overview

Plan Details for Blue Cross Medicare Advantage Protect

This Medicare Advantage Preferred Provider Organization (PPO) plan provides access to Medicare-approved providers and covers Medicare Part A and Part B services. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: 50% coinsurance, specialist visits come with a $50 copay | Out-of-network: 50% coinsurance, urgent care services carry a $40 copay, and ambulance transportation is $350 copay | Out-of-network: $350 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6500.00. Once this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H0107-011. Cost-sharing details for key services are provided below.

Cost Sharing Expenses

Blue Cross Medicare Advantage Protect has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H0107-011.

Certain preventive services are covered 100% by Blue Cross Medicare Advantage Protect as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

Medicare Plan Star Ratings

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.